Why the Jimmo v. Sebelius Case Matters: Improvement Standard Stories

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Mrs. Jimmo

Lead plaintiff in the Improvement Standard case, Glenda Jimmo of Bristol, Vermont is blind and has had her right leg amputated due to complications from diabetes. She requires a wheelchair, and receives multiple home health care visits per week for various treatments for her complex condition. However, Medicare denied coverage for these services, saying that she was unlikely to improve.

Mrs. Berkowitz

Since 1987, Mrs. Berkowitz, an 81 year-old woman with Multiple Sclerosis, has frequently been told that her Medicare coverage and home health services are being discontinued because her MS “is not improving.” Each time, she has called on the Center for Medicare Advocacy to fight for her and ensure that her care continues. Each time, the Center has successfully advocated to keep her Medicare and home care in place. People like Mrs. Berkowitz helped the Center know how harmful this illegal basis for Medicare denial is for people with long-term and chronic conditions. As a result of working with her, and many other people with long-term conditions, the Center has been able to seek, and obtain, systemic change to help ensure fair access to Medicare coverage and necessary health care for all beneficiaries in similar circumstances

Ms. Masterman

Edith Masterman: Fighting to Keep Medicare Services

Jane, in Texas

“My husband is one of the few remaining World War II veterans who served in both the Atlantic and Pacific theaters. He joined the U.S. Navy right after Pearl Harbor and even served in the Battle of Iwo Jima. He has suffered from Parkinson’s disease for several years, and he recently fell in our home. After he was released from the hospital, he was transferred to a skilled nursing facility. After some time, his Medicare coverage was terminated because he was not ‘improving.’ We have already appealed multiple times.”

Tom, in Arkansas

“I was a practicing physical therapist who left the health and nursing home field and began practicing law because of this very issue – I was being forced to discharge clients much sooner than they should have been, and their coverage would decline without skilled care, but it wouldn’t be covered since they were not ‘making progress.’ I refused to be a part of this system and resigned.”

Veronica, in New Hampshire

“These changes [from the Jimmo Settlement] are extremely meaningful, as my mother has repeatedly been denied the ability to continue the physical therapy she needs in order to prevent further deterioration of her condition. It has been extraordinarily frustrating, and after the last cessation of PT and subsequent deterioration actually endangered her life, her quality of life was greatly affected, resulting in extremely expensive 24/7 care. If she could have kept her PT services, this would not have happened!”

Share Your Story

Under the Jimmo Settlement Agreement, the Center for Medicare Advocacy and Vermont Legal Aid will be monitoring compliance with the terms of the settlement. We want to hear from you.